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Technetium 99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting. The Nuclear Utility in the Community (NUC) Study.

Abstract：

OBJECTIVES:The purpose of this study was to evaluate the prognostic value of community-based myocardial perfusion imaging (MPI) and to assess the incremental value of individual components of (99m)Tc-sestamibi single photon emission computed tomography (SPECT). BACKGROUND:Although the most rapid growth of MPI has been in community outpatient laboratories, its prognostic value has not been validated in this setting. METHOD:We prospectively followed 1,612 consecutive patients undergoing stress (99m)Tc-sestamibi SPECT in an outpatient community laboratory who experienced 71 hard events over 24 +/- 7 months (0.2% lost to follow-up). RESULTS:Patients whose scans were normal incurred an annualized event rate of 0.4%, compared with 2.3% for those with abnormal scans (p < 0.0001). Subset analysis demonstrated comparable risk stratification for women and men, diabetics, patients with normal resting ECGs, and those referred for pharmacologic and exercise stress. After adjusting for pre-test variables, multivariable Cox regression analysis found the most potent independent components of MPI to be, in order of importance, transient ischemic dilation, extent of reversibility, post-stress ejection fraction, extent and severity of the stress perfusion defect, and the overall test result (normal or abnormal). Each 1% decrement of ejection fraction predicted a 3% increase in risk (p = 0.0009). Post-MPI angiography and revascularization increased commensurate with the extent and severity of MPI result. CONCLUSIONS:The prognostic value of perfusion imaging is portable and transferable to the outpatient community setting, with multiple components of MPI providing incremental prognostic information.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Thomas GS,Miyamoto MI,Morello AP 3rd,Majmundar H,Thomas JJ,Sampson CH,Hachamovitch R,Shaw LJ

doi

10.1016/j.jacc.2003.07.041

subject

Has Abstract

pub_date

2004-01-21 00:00:00

pages

213-23

issue

eissn

0735-1097

issn

1558-3597

pii

S0735109703014220

journal_volume

pub_type

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Technetium 99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting. The Nuclear Utility in the Community (NUC) Study.